Prevalence and factors associated with undiagnosed and uncontrolled heart disease: A study based on self-reported chronic heart disease and symptom-based angina pectoris among middle-aged and older Indian adults

Gender and Age Differentials in Prevalence and Pattern of Nine Chronic Diseases Among Older Adults in India: An Analysis Based on Longitudinal Ageing Study in India

Non-communicable diseases (NCDs) account for a major portion of morbidity and mortality worldwide, with older persons being especially vulnerable due to age-related health concerns. The burden of chronic diseases among India's aging population is understudied, particularly in terms of gender and age differences. The study utilized data from the Longitudinal Ageing Study in India (LASI), wave 1 (2017-18), comprising a sample of 66,606 older adults aged 45 years and above. We performed a Mmultivariable logistic regression analysis to examine the age-gender differences in the prevalence and patterns of nine chronic diseases, namely hypertension, diabetes, cancer, chronic heart disease, stroke, psychiatric disorders, chronic lung disease, bone and joint diseases, and high cholesterol among older adults after adjusting for various socio-demographic and lifestyle factors. Compared to male respondents, female older respondents were less likely to have diabetes and stroke (in the 45-59 and 60-69 years age groups), chronic lung diseases (in the 45-59 years age group), and chronic heart diseases (in the 60-69 years age group). Conversely, in the 70 years and above age group, older female respondents had higher odds of having hypertension and bone and joint diseases compared to male respondents. The current study revealed significant gender and age-related differences in the prevalence and odds of all the nine selected diseases even adjusted for potential confounding factors. The findings highlight how urgently age- and gender-specific treatments are needed to reduce inequities in chronic diseases, boost positive health outcomes, and improve the quality of life for India's aging populations.

Prevalence of Angina Pectoris: An Analysis of the National Health Interview Survey (NHIS) Database

BACKGROUND

Angina pectoris remains a significant public health concern, highlighting disparities in cardiovascular health influenced by demographic, socioeconomic, and geographic factors. Analyzing the prevalence of trends is crucial to addressing health inequities and informing targeted interventions. The study of National Health Interview Survey (NHIS) data from 2019 to 2023 allowed us to observe how the pandemic affected cardiovascular care utilization when it decreased in 2020 and later rebounded into 2023 while investigating shifts in reported angina prevalence rates among main groups. Angina pectoris condition-related research requires assessment of current trends for effective health inequities intervention and targeted intervention planning.

OBJECTIVE

This study aims to examine the prevalence of angina pectoris among United States (US) adults from 2019 to 2023 and across demographic, socioeconomic, and geographic factors.

METHOD

Data from the NHIS were analyzed to determine the prevalence of angina pectoris, which was identified through self-reported diagnosis or symptoms. The identification of angina pectoris in the NHIS dataset was based on self-reported physician diagnosis alongside responses to definite survey questions regarding chest pain and discomfort consistent with the symptoms of angina. Angina pectoris was identified in the NHIS dataset based on self-reported physician diagnoses and responses to specific survey questions on chest pain or discomfort consistent with angina. Stratified analyses assessed variations in prevalence across key demographic, socioeconomic, and geographic factors over a five-year period. The statistical analyses included both inferential analyses and descriptive statistics, including hypothesis testing and confidence interval estimation, to evaluate associations and divergences within the data. The prevalence of angina was evaluated across socioeconomic, demographic, and geographic groups using stratified analyses.

RESULTS

The overall prevalence of angina pectoris remained stable (1.5-1.7%) from 2019 to 2023. Higher rates were observed among males (1.8%), older adults (4.5% in those aged 75 years and older), and US-born individuals (1.6%). Disparities observed across race/ethnicity further revealed disparities, with American Indian/Alaska Native individuals (2.1%) and Black individuals (1.2%) showing distinct patterns. Geographic trends highlighted a higher prevalence in areas with high social vulnerability (1.7%). Socioeconomic disparities were notable, with lower-income individuals (<100% federal poverty level (FPL)) experiencing higher prevalence (2.8-3.1%) and elevated rates among those with lower educational attainment. Employment status influenced prevalence, with unemployed individuals showing higher rates (3.4%).

CONCLUSION

The prevalence of angina pectoris reflects persistent disparities across demographic, socioeconomic, and geographic factors. The findings highlight the need for policies that enhance access to preventive cardiovascular care, early screening, and intervention, as well as address the social determinants of health, to minimize disparities in underserved populations.

Efficacy and Safety of Stellate Ganglion Block for Treating Angina Pectoris: A Systematic Review and Meta-Analysis

Purpose: This systematic review and meta-analysis of randomized controlled trials (RCTs) is aimed at assessing the clinical efficacy and safety of stellate ganglion block (SGB) for angina pectoris (AP). Methods: PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang databases were comprehensively searched for RCTs investigating SGB treatment for AP. The retrieval time was from the establishment date of each database to October 10, 2024. The Cochrane risk of bias assessment tool was used to determine the methodological quality. Review Manager 5.4 software was employed for data analysis, and GRADEpro GDT software was utilized to evaluate the quality of evidence. Results: Ultimately, six RCTs were included, encompassing 373 patients with angina. The overall methodological quality of the included studies was moderate, with the evaluation of evidence quality showing 12 low-quality and five extremely low-quality studies. The meta-analysis results demonstrated that compared with the control group, the experimental group had lower frequency and duration of AP, visual analog scale score, heart rate, detection rate of S-T segment elevation ≥ 0.1 mV on electrocardiogram (ECG) after 24 h of treatment, detection rate of abnormal T waves on ECG after 24 h of treatment, and S-T segment displacement on ECG after treatment. Furthermore, the experimental group exhibited lower serum Cardiac Troponin I levels, a decreased incidence of acute myocardial infarction (AMI) and rehospitalization, and improved clinical efficacy. However, none of the included studies reported SGB-related adverse events. Conclusion: SGB is effective in alleviating myocardial injury and reducing the incidence of AMI and rehospitalization in patients with AP. Nevertheless, the limited number and relatively low quality of included studies emphasize the requirement for more high-quality research to verify these conclusions.

Causal Effects of Sleep Traits on Angina Pectoris: Mediation by Cardiovascular Risk Factors

Purpose

Angina pectoris (AP) is a major factor in heightened risk of cardiac arrest and has been previously linked to sleep patterns. It remains unclear if sleep traits play a role in the onset of AP. Our study aims to declare the causality of sleep traits on AP by Mendelian randomization (MR) analyses.

Methods

Genome-wide association study (GWAS) data of sleep traits (sleep duration, insomnia, nap during day, chronotype, getting up in morning, narcolepsy, snoring) were obtained from the UK Biobank. The AP datasets came from an analysis containing samples from the UK biobank, FinnGen, and BioBank Japan. The GWAS data of cardiovascular risk factors (hypertension, smoking, hyperlipidemia, type 2 diabetes mellitus (T2DM)) came from the FinnGen. Two-sample MR analyses were carried out to gain a general map of sleep traits, risk factors and AP, then a multivariable MR was performed and the effect of each factor was calculated.

Results

We discovered a positive association between nap, narcolepsy, insomnia and stable angina pectoris (SAP), while getting up in morning associated with SAP negatively. Adequate sleep duration related to a reduced risk of SAP and unstable angina pectoris (UAP). Hypertension and T2DM acted as complete mediators in the relationship of nap and SAP, with an effect value of 1.267 (95% CI = 1.178-1.363, P < 0.01) and 1.059 (95% CI = 1.000-1.120, P < 0.05), and the mediating proportion was 27.7% (P < 0.05) and 7.70% (P = 0.102).

Conclusion

Our study found that nap, narcolepsy, and insomnia increased the risk of SAP, with hypertension and T2DM mediating the causal relationship between nap and SAP. Getting up in the morning reduced the risk of SAP, while longer sleep duration lowered the risk of SAP and UAP. More evidences are required to clarify the roles of sleep traits and risk factors in AP.

Additive interaction of family medical history of cardiovascular diseases with hypertension and diabetes on the diagnosis of cardiovascular diseases among older adults in India

Introduction

The present study aimed to examine the additive interaction of family medical history of cardiovascular disease (CVD) and self-reported hypertension and diabetes on the diagnosis of CVD among older adults aged 45 years and above in India. A family medical history of CVD in individuals with hypertension and diabetes could identify a subpopulation with a higher risk of CVD.

Methods

The study used the data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The total sample size for the study was 58,734 older adults aged 45 years and above. An additive model was applied to determine the additive interaction effect of the family medical history of CVD with hypertension and diabetes on the diagnosis of CVD by calculating three different measures of additive interaction: the relative excess risk due to interaction (RERI), attribution proportion due to interaction (AP), and synergy index (S).

Results

The prevalence of CVD was higher among hypertensive individuals with a family medical history of CVD (18.6%) than individuals without the coexistence of family medical history of CVD and hypertension (4.7%), and hypertensive individuals without family medical history of CVD (11.3%). On the other hand, the prevalence of CVD was higher among individuals with diabetes and family history of CVD (20.5%) than individuals without the coexistence of family history of CVD and diabetes (5.0%). Individuals with parental and sibling medical history had two times higher odds of having chronic heart diseases and strokes, respectively than those without parental and sibling history. In the adjusted model, RERI, AP, and S for CVD were 2.30 (95% CI: 0.87-3.74), 35% (0.35; 95% CI: 0.20-0.51), and 1.71 (95% CI: 1.27-2.28) respectively, demonstrating significant positive interaction between family medical history and hypertension on the diagnosis of cardiovascular diseases.

Conclusions

The present study revealed that in the additive model, the interaction effects of family medical history and hypertension were significantly positive on cardiovascular diseases even after adjustment with potential confounding factors. Therefore, it is crucial to consider the presence of family medical history of CVD among individuals with hypertension and diabetes measured in research and clinical practice.

Exposure to indoor air pollution and angina among aging adults in India: evidence from a large-scale nationwide study

This study tried to understand the association between exposure to indoor air pollution and angina among the aging population in India. We utilized the data from the Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018), with a sample of 62,846 aging adults. We applied Chi-square and multivariate logistic regression models. The odds of angina were higher among individuals living in households that used solid fuels for cooking (aOR = 1.15, 99% CI- 1.09-1.20), had someone smoked inside the house (aOR = 1.12, 99% CI- 1.07-1.18), and households that used of incenses inside the home (aOR = 1.11, 99% CI- 1.05-1.18). In addition, it was also found that work-limiting impairment, unhealthy behaviors, and poor health status increased the odds of angina. These results indicate the need to reduce in-house air pollution by promoting clean fuel usage and changing attitudes and practices. Other implications are discussed.

A 3D in-vitro biomimicking Caco-2 intestinal permeability model-based assessment of physically modified telmisartan towards an alkalizer-free formulation development

Efficient telmisartan delivery for hypertension management requires the incorporation of meglumine and/or sodium hydroxide as an alkalizer in the formulation. Long-term use of powerful alkalis with formulation as part of chronic therapy can cause metabolic alkalosis, ulcers, diarrhea, and body pain. Here, we aimed to design a telmisartan formulation without alkalizers. Telmisartan properties were tailor-made by microfluidizer-based physical modification. After microfluidization, telmisartan nanosuspension was lyophilized to obtain telmisartan premix powder. The optimized telmisartan nanosuspension had an average particle size of 579.85 ± 32.14 nm. The lyophilized premix was characterized by FT-IR, DSC, and PXRD analysis to ensure its physicochemical characteristics. The solubility analysis of premix showed 2.2 times, 2.3 times, and 6 times solubility improvement in 0.1 N HCl, phosphate buffer pH 7.5, and pH 6.8 compared to pure telmisartan. A 3D in-vitro Caco-2 model was developed to compare apparent permeability of API and powder premix. It showed that the powder premix was more permeable than pure API. The tablet formulation prepared from the telmisartan premix showed a dissolution profile comparable to that of the marketed formulation. The technique present herein can be used as a platform technology for solubility and permeability improvement of similar classes of molecules.

Geospatial variation in dietary patterns and their association with heart disease in Bangladeshi population: Evidence from a nationwide survey

Heart disease is a significant public health threat, and its burden is increasing worldwide. Recent evidence suggests that dietary pattern is a key modifiable factor for heart disease. Research regarding dietary patterns and heart disease in Bangladesh with their spatial variability is limited. In this study, the spatial variation and relationship between dietary patterns and heart disease among Bangladeshi people was investigated. The country-representative Household Income and Expenditure Survey 2016 dataset was used, and a total of 77,207 participants aged 30 years and over were included. A principal component analysis was conducted to derive the dietary patterns. Both statistical and spatial analyses were performed. The overall prevalence of heart disease was 3.6%, with a variation of 0.6% to 10.4% across districts of Bangladesh. Three major dietary patterns, named "festival pattern", "pickles and fast foods pattern", and "rice and vegetable pattern" were identified, accounting for 25.2% of the total dietary variance. Both the dietary pattern and heart disease rate varied across the region. A higher risk of heart disease was persistent in the western-south, southern, central, and eastern regions, as was greater adherence to the "festival pattern" and "pickles and fast foods pattern." After adjusting for confounders, participants with the highest adherence to the "rice and vegetable pattern" were associated with a lower likelihood of developing heart disease (AOR: 0.78, 95% CI: 0.64-0.95, p <0.05), while the highest adherence to the "pickles and fast foods pattern" was associated with a higher likelihood of developing heart disease (AOR: 1.50, 95% CI: 1.27-1.76, p <0.001). The spatial disparities in the prevalence of heart disease and dietary patterns underscore the significance of prioritizing intervention at the district level, especially in the western-south, southern, central, and eastern regions, to control the rising heart disease trends in Bangladesh.

Cardiovascular Diseases Among Indian Older Adults: A Comprehensive Review

Cardiovascular diseases (CVDs) constitute an important cause of morbidity and mortality globally, and India is no exception to this trend. With the ongoing aging of the population in India, there is a notable surge in the prevalence and impact of CVDs among older adults. This review is aimed at providing a comprehensive overview of the current knowledge concerning the prevalence, risk factors, and management of CVDs in the context of Indian older adults. The incidence of CVDs in India is not only alarming but also exhibits an upward trajectory with advancing age. Primary risk factors contributing to the elevated incidence among older adults include hypertension (HT), diabetes, dyslipidemia, obesity, smoking, a sedentary lifestyle, and poor dietary habits. Additionally, stress and genetic predisposition emerge as noteworthy contributors to CVDs in this population. Effectively identifying and managing these risk factors among older adults in India is imperative to alleviate the burden of these diseases and enhance overall quality of life. Strategies aimed at mitigating the impact of CVDs in the country necessitate a comprehensive approach, integrating lifestyle interventions, public health initiatives, and a robust healthcare system. In summary, CVDs represent a significant health concern in both rural and urban areas of India. However, variations exist in the prevalence, risk factors, and accessibility to healthcare between these regions. Therefore, addressing the prevalence of CVDs in India necessitates a complex, multidimensional strategy that takes into account the unique opportunities and challenges that come with living in both rural and urban areas.

Effect of chronic lung diseases on angina pectoris among Indian adults: longitudinal ageing study in India

The study aimed to evaluate the effect of chronic lung diseases, namely chronic obstructive pulmonary diseases (COPD) and asthma, on angina pectoris in individuals aged 45 years and above. Identifying vulnerable subpopulations suffering from COPD and asthma at higher risk of future cardiovascular events using the rose angina questionnaire is imperative for tailored primary and secondary prevention approaches. The present study utilizes the data from the Longitudinal Ageing Study in India, wave 1, conducted during 2017-2018. The sample size included 58,830 individuals aged 45 years and above. Angina was measured based on seven questions from Rose's questionnaires. Descriptive statistics and bivariate analysis were employed to examine the prevalence of angina among individuals with COPD and asthma. Further, multivariable logistic regression and propensity score matching (PSM) methods were used to assess the independent effect of COPD and asthma on angina after controlling the selected background characteristics. We employed PSM in two different models and included various additional factors in model 2, such as smoking, chewing tobacco, alcohol use, ADL, IADL, body mass index, physical activity, high cholesterol, hypertension, diabetes, and chronic heart disease. The current study shows that the prevalence of angina pectoris, COPD and asthma was 6.0%, 2.3% and 4.7%, respectively, among individuals aged 45 years and above in India. The prevalence of angina pectoris was higher among individuals with COPD (9.6% vs. 5.8%) and asthma (9.9% vs. 5.7%) than those without COPD and asthma, respectively. Additionally, angina pectoris was more prevalent among females and rural respondents with COPD (10.8% and 11.0%) and asthma (10.3% and 10.3%) compared to males and urban respondents with COPD (8.0% and 5.7%) and asthma (8.9% and 7.9%). Moreover, in the adjusted model, individuals with COPD (AOR 1.43, 95% CI 1.03 1.98) and asthma (AOR 1.44, 95% CI 1.17 1.77) had nearly 1.5-fold higher odds of having angina pectoris than those without COPD and asthma. The PSM estimates showed that individuals with COPD had 8.4% and 5.0% increased risk of angina pectoris compared to those without COPD in model 1 and model 2, respectively. We observed that, after adjusting to lifestyle, health-related and morbidity factors in model 2, both average treatment effect on untreated (ATU) and average treatment effect (ATE) values decreased by nearly 3.5%. Additionally, the PSM estimates demonstrated that individuals with asthma had a 3.4% and 2.9% increased risk of angina pectoris compared to those without asthma in model 1 and model 2, respectively. The study suggests that COPD and asthma are significantly associated with angina pectoris, and individuals with COPD and asthma have a higher risk of developing angina pectoris. Additionally, angina pectoris was more prevalent among females, rural respondents and adults aged 45-54 with COPD compared to males, urban respondents and those aged 65 and above, respectively, with COPD. Moreover, the findings of our study underscore the targeted primary and secondary interventions and team-based care approach among individuals with COPD and asthma to reduce the risk of CVD events in future.

Causal Relationship between Angina and Hepatic Failure as Revealed by Mendelian Randomization

BACKGROUND

Patients with angina are often suffering from comorbidities such as varying degrees of hepatic dysfunction. However, the impact of angina on the incidence of hepatic failure (HF) remains unclear.

METHODS

The genetic data were retrieved from genome-wide association studies. Five Mendelian randomization methods were used to investigate the causal relationship between unstable angina (UA), stable angina (SA), and HF. The result of the Inverse variance weighted (IVW) method was deemed the principal result. In addition, we performed a comprehensive sensitivity analysis to verify the robustness of the results.

RESULTS

The IVW results showed that UA (Odds ratio (OR): 2.055, 95% confidence interval (CI): 1.171-3.606, p = 0.012) was causally associated with the incidence of HF. SA (OR: 1.122, 95% CI: 0.738-1.706, p = 0.591) was not causally associated with the incidence of HF. Sensitivity analysis did not identify any bias in the results.

CONCLUSIONS

UA turned out to be a risk factor for HF. SA does not have a significant causal effect on HF. Therefore, it is highly recommended that patients with chronic liver disease seek prompt medical attention and undergo regular monitoring of liver function when experiencing UA. This may help them to reduce the risk of HF.

Epidemiological Situation of High-Prevalence Non-Communicable Diseases in Spain: A Systematic Review

High-prevalence non-communicable diseases (HNCDs) are an ongoing global public health problem, posing a risk to the continuity of the 2030 Agenda for Sustainable Development. The aim of this study is to describe the current situation in Spain regarding certain HNCDs, namely, ischaemic heart disease, type 2 diabetes mellitus and colorectal cancer, including their prevalence and incidence in recent years. A systematic review was conducted between October 2022 and February 2023 using the MEDLINE, ProQuest and Scopus databases. After an exhaustive search, a total of thirty-four articles were included, comprising fourteen articles on colorectal cancer, seven on ischaemic heart disease and thirteen on diabetes mellitus type 2. The main topics included risk factors, lifestyles, mortality and incidence, the importance of screening and patient empowerment. On analysing each disease, it can be gleaned that risk factors and lifestyle impact the incidence, prevalence and mortality of the diseases studied. In addition, responsible human behaviour, associated with lifestyle factors, is related to the occurrence of these three diseases.